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Gastroenterology Flashcards

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1
Q

Causes of B12 deficiency - 4

A

Pernicious Anemia,
H.pylori
Alcoholism / Malnutrition
Gastrectomy

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2
Q

vitamin B12 is important in both

A

the production of blood cells and the myelination of nerves → megaloblastic anaemia and neuropathy

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3
Q

Pernicious Anemia Risk Factors

A

Female >Male
Middle to elderly
Autoimmune disease - Thyroid / T1DM/ Addisons / Vitiligo/ Rheumatoid.
Blood Group A.

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4
Q

What type of Anemia is B12 and what antibodies

A

Macrocytic anaemia.
Anti - Intrinsic factor antibodies
Anti gastric parietel cells.

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5
Q

What is regime of B12 to give and how is it given

A

IM , Load with 6 injections over 2 weeks
then every 3 months.

more frequently if neurological dysfunction

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6
Q

Replace B12 or folate first

A

B12 to prevent exacerbation of the vitamin B12 deficiency and precipitation of subacute combined spinal cord degeneration.

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7
Q

Mesalazine and Epigastric pain / RUQ pain

A

Pancreatitis - sulfasalazine.

mesalazine = 7x more likely to get pancreatitis

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8
Q

What blood test to watch out for in mesalazine

A

Agranulocytosis - FBC

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9
Q

what are 3 things defining malnutrition according to NICE

A

BMI < 18.5
Unintentional weight loss >10% in 3-6 months
BMI <20 and UIWL of >5% in 3 -6 months.

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10
Q

what is malnutrition screening tool

A

MUST

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11
Q

what is malnutrition screening tool

A

MUST

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12
Q

Dietary advice for IBS (10 pieces)

A 
regular meals and take time 
Avoid missing meals 
Drink 8 cups of fluid per day 
restrict tea and coffee to 3 cups 
limit High fibre intake food 
reduce processed and resistant starch food (low GI) 
fresh fruit - 3 portions a day 
avoid alochol and fizzy 
avoid sorbitol 
for wind and bloating increase oats and linseeds.
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13
Q

how to deal with IBS

  • pain
  • constipation less than 12 months and more
  • diorrhoea
A

Antispasmodic
laxative but avoid lactulose
if more than 12 months linaclotide.
loperamide.

can use amitryptaline antidepressant.

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14
Q

what is a complications of long term PPi use (electrolyte)

A

hypomagnesaemia.

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15
Q

what is xerostemia

A

Dry Mouth

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16
Q

Difference between Primary Sjogrens and PBC

A

PBC has liver involvement - deranged bili and ALP.

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17
Q

Primary Biliary Cirrhosis - male or female

A

female > male 9 times

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18
Q

what is PBC associated with

A

Sjogrens syndrome
RA
Systemic Sclerosis
Thyroid disease .

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19
Q

https://pscpartners.org/patients-caregivers/education/psc-pbc.html

A
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20
Q

Chrons - what indicates a worse prognosis

A

Perianal disease

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21
Q

Chrons - what indicates a worse prognosis

A

Perianal disease

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22
Q

What is link between chrons /UC and smoking

A

Risk of CHRONS is incrased in smokers (Decreased in UC)

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23
Q

Extra Intestinal Manifestation of Chrons associated with DISEASE activity

A

Apthous mouth ulcers

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24
Q

what is link of osteoporosis and Chrons

A

30%

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25
Chrons - what is extra intestinal diseas not assoicated wtih disease activity
Psoriasis.
26
Introducing Remission for Chrons
``` Glucocorticoid Enteral feeding 5-ASA drug - mesalazine Azathioprine / Methotrexate- add on NOT monotherapy Infliximab in fistulating chrons ```
27
treatement of isolated peri-anal disease
metronidazole o
28
maintaining remission
Stop Smoking | Azathioprine or Mercaptopurine - maintain remisison .(assess TMPT activity before treatment)
29
how many patients end up having surgery in chrons
80%
30
FODMAP diet is what
IBS - Fermentable oligo di mono sach and poly sach. Wheat Dairy, Fructose and vegetables. Low intake of them
31
LOWFLEX Diet
Low Fat, Fibre exclusion - helps with chrons disease. avoid high fibre and fat.
32
women who breastfeed and vegan diet what vitamin should they take
B12 - mainly found in meats and milk | women should also take vit D 10mcg.
33
Complication of GORD - 4
``` Carcinoma Barretts Anemia Strictures. Ulcers ```
34
endoscopy proven Oesophagitis mx
Full dose PPI 1-2 months if response then low dose PRN if no response then double dose PPI for 1 month.
35
Endscopic Negative Reflux disease
Full dose PPi for 1 month If response - PRN low dose If no response then H2RA or prokinetic
36
Dyspepsia Urgent referral
``` All patients with dysphagia All patients with upper abdo mass >55 Y with W(eight loss) + any of following - A(nemia) - Reflux -Dyspepsia. ```
37
Non urgent referral to Endoscopy
1) haematemesis 2) >55 - RUR - resistant dyspepsia / upper abdo pain + low Hb / Raised Platelet + N+V + WARD(only 1) 3) >55 years with N+V WARD.
38
which antibiotic can cause cholestasis
Flucloxacillin
39
H.pylori Eradication treatment
PPI+clarithromycin + amoxicillin | if can't tolerate amox - then metro nidazole.
40
wheat / bread/ oats/ rye / potatoes/ beer/ pasta/ barley/ rice/ pastry/ corn (maize) which ones Gluten free
Corn. Rice. Potatoes.
41
C diffe is what type of organism on microscope
Gram positive Rod
42
which Abx cause Cdiffe
broad spec - used to be clindamycin but now 2nd /3rd gen cephalosporin omemrazole (PPi)
43
treatment of Cdiffe 1st to 2nd to 3rd line
Oral Vanc for 10/7 second line is oral fidaxomicin third line - oral vanc and IV metro
44
Vitamin C def symptos
Gingitivits , Loose teeth poor wound healing bleeding gums, haematuria , epistaxix general tiredness - can lead to anemia.
45
biochemically what is seen in NAFLD LFTs
ALT>AST.
46
If NAFLD found - what next
Extensive Liver Fibrosis screen (ELF) `
47
what scoring system to assess severity of fibrosisi
FIB 4 and NAFLD fibrosis score. and FIBRO scan.
48
treatment of gallstones
If asymptomatic observe | if symptomatic - operate. Lap Chole
49
which diabetic drugs cause cholestasis
Sulphonyl urea - gliclazide
50
5 drugs which cause hepatocellular picture of LFT
Paracetamol / Phenytoin/ Sodium Valproate/ RIPE (tb) / Alcohol/ Statin/ Amiodarone / Methyldopa / Nitrofurantoin
51
5 drugs which cause cholestatic +/- hepatitis
COCP/ Antibiotics / Anabolic steroids / Testostarone / cHLORPROMAZINE / Sulphonyl urea/ Fibrates.
51
5 drugs which cause cholestatic +/- hepatitis
COCP/ Antibiotics / Anabolic steroids / Testostarone / cHLORPROMAZINE / Sulphonyl urea/ Fibrates.
52
NSAID and COCP what do they do in chrons
Increase risk of flare up
53
how many chrons patients end up having surgery
80%
54
which test to test for h.PYLORI
Urea breath test. 13C.
55
which screening tool for alcohol recommended by NICE
AUDIT or AUDIT - C
56
how long must patients eat gluten before coeliac screen
6 weeks
57
Liver and Neurological signs
Wilsons disease
58
which blood tests to check Heb B immunisation
Anti-Hbs
59
which blood test for Heb B active infection
HBsAG
60
what level of bilirubin do you need to admit for
>100
61
what do you give for UC remission to maintain and when
>2 years since exacerbation - give Azathioprine or oral mercaptopurine

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